Healthcare Provider Details

I. General information

NPI: 1124013347
Provider Name (Legal Business Name): RICHARD HOFFMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 VICTORY BLVD
STATEN ISLAND NY
10301-3914
US

IV. Provider business mailing address

1460 VICTORY BLVD
STATEN ISLAND NY
10301-3914
US

V. Phone/Fax

Practice location:
  • Phone: 718-442-0300
  • Fax:
Mailing address:
  • Phone: 718-442-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number096587
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: